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PubMed1997

Current aspects of spontaneous pneumothorax.

Although spontaneous pneumothoraces have been recognized and treated for almost 180 yrs, new aspects have emerged concerning pathogenesis, diagnostic procedures and treatment modalities. In spite of the fact that blebs and bullae are frequently found in patients with primary spontaneous pneumothorax, they seldom seem to be the actual cause of the pneumothorax. Inflammatory changes in the distal airways play an important role in the occurrence of the pneumothorax during transpulmonary pressure changes. The value of the routine use of additional expiratory chest radiographs in diagnosing pneumothoraces has been doubted in previous studies. In this review, the diagnostic yield from additional expiratory chest radiographs is analysed. The role of previous pneumothoraces at presentation and the presence of blebs and bullae are discussed in predicting future recurrences and choosing appropriate treatment for optimal cost-effectiveness. Recommendations are made regarding treatment of primary and secondary spontaneous pneumothorax.

Humans↗
PubMed1998

Respiratory bronchiolitis in smokers with spontaneous pneumothorax.

Respiratory bronchiolitis (RB) is defined by the accumulation of pigmented macrophages in the lumen and wall of respiratory and membranous bronchioles of smokers. The aim of this study was to determine whether spontaneous pneumothorax was associated with a high prevalence of RB. Seventy-nine consecutive patients who underwent a surgical procedure (thoracotomy or thoracoscopy) for recurrence or persistence of primary spontaneous pneumothorax despite thoracic drainage were studied retrospectively. RB was found in 70 of 79 (88.6%) smokers operated for spontaneous pneumothorax. Associated interstitial pathological abnormalities were present in 53 of 79 cases (67.1%). In nine patients, the pathological lesions were severe and resembled desquamative interstitial pneumonia. Emphysematous lesions were present in about one-third of the patients. Although the possible pathophysiological consequences of respiratory bronchiolitis remain speculative, this study demonstrates the high prevalence of this pathological abnormality in patients with pneumothorax requiring surgical treatment.

Adolescent↗
PubMed2006

Management approach for recurrent spontaneous pneumothorax in consecutive pregnancies based on clinical and radiographic findings.

OBJECTIVE: To describe management and clinical features observed in a patient's seven spontaneous pneumothoraces that developed during two consecutive pregnancies involving both hemithoraces. MATERIALS AND METHODS: A 21 year old former smoker developed three spontaneous left pneumothoraces in the index pregnancy, having already experienced four right pneumothorax events in a prior pregnancy at age 19. RESULTS: Chest tubes were required in several (but not all) hospitalizations during these two pregnancies. Following her fourth right pneumothorax, thoracoscopic excision of right apical lung blebs and mechanical pleurodesis was performed. The series of left pneumothoraces culminated in mini-thoracotomy and thoracoscopically directed mechanical pleurodesis. For both pregnancies unassisted vaginal delivery was performed with no adverse perinatal sequelae. With the exception of multiple pneumothoraces, there were no additional pregnancy complications. CONCLUSION: Spontaneous pneumothorax in pregnancy is believed to be a rare phenomenon, yet the exact incidence is unknown. Here we present the first known case of multiple spontaneous pneumothoraces in two consecutive pregnancies involving both hemithoraces. Clinical management coordinated with obstetrics and surgical teams facilitated a satisfactory outcome for both pregnancies. The diagnosis of pneumothorax should be contemplated in any pregnant patient with dyspnea and chest pain, followed by radiographic confirmation.

Female↗
PubMedDate not supplied

Diagnosis of pneumothorax complicating mechanical ventilation.

Pneumothorax developed in 4 patients as a complication of mechanical ventilation and the manifestations were different in each case. The first patient had had a previous pneumomediastinum with symptoms of chest pain and rise in blood pressure. The second became restless and "fought" the ventilator. The third had pneumothorax previously and developed tachycardia and arrhythmias, and the level of end-expiratory pressure in the manometer of the ventilator rose above the present level. In the fourth patient, subcutaneous and submucous emphysema were apparent before pneumothorax was diagnosed. Pneumothorax was diagnosed promptly in all these patients, permitting adequate management without additional complications.

Adolescent↗
PubMed1993

Supraclavicular nerve block: anatomic analysis of a method to prevent pneumothorax.

Supraclavicular nerve blocks are technically easy to perform, but may be associated with pneumothorax. The objective of this study is to define the parasagittal anatomy important to our modified technique of supraclavicular nerve block designed to decrease the incidence of pneumothorax and to determine whether this technique is anatomically sound. Two cadaver specimens were studied. One embalmed specimen was dissected to establish the relationship of the brachial plexus to our modified needle entry site. The neck and upper thorax of an unembalmed cadaver were frozen, and parasagittal serial sections were made to establish the relationship of the brachial plexus to surface features and the chest cavity. Additionally, 12 volunteers underwent magnetic resonance (MR) imaging and anatomic measurements of their supraclavicular anatomy important to our modified block. MR imaging showed that in no instance using our modified technique was the lung contacted by the simulated needle before entering either the subclavian artery or contacting the brachial plexus. Our technique has been used in more than 110 patients without pneumothorax. The combination of our cadaver and magnetic resonance data suggests that our plumb-bob technique of supraclavicular nerve block is anatomically sound and may minimize the development of pneumothorax during supraclavicular block.

Brachial Plexus↗
PubMed2005

Bilateral tension pneumothorax following rigid bronchoscopy: a report of an epignathus in a newborn delivered by the EXIT procedure with a fatal outcome.

We describe a case of a newborn baby with a prenatal diagnosis of an epignathus (oropharyngeal teratoma). With the potential for airway problems at birth, he was delivered by an elective EXIT (Extra Utero Intrapartum Treatment) procedure at 38 weeks of pregnancy. The airway was secured and rigid bronchoscopy performed. Initially he was stable, but developed cardiorespiratory difficulties 40 minutes after birth and died from a cardiac arrest 17 minutes later. Tension pneumothorax is a devastating complication that can occur with lower airway manipulation for anaesthesia and rigid bronchoscopy. The addition of positive pressure during mechanical ventilation converts the pneumothorax into a tension pneumothorax. The possibility of tension pneumothorax should be entertained in a mechanically ventilated patient whose ventilatory pressures are increasing, with diminishing cardiac output. A complicated case is presented, where the diagnosis was missed with a fatal outcome.

Bronchoscopy↗
PubMed1991

The thoracic vent. Clinical experience with a new device for treating simple pneumothorax.

We report recent experience with a new device, the thoracic vent, in the management of simple pneumothorax. There were 16 patients aged 19 to 73 years who suffered pneumothorax due to spontaneous (4), traumatic (3), or iatrogenic (9) causes. Ease of insertion, patient tolerance, and the presence of a unique signal diaphragm all contributed to patient and physician acceptance of the device. Average time to pneumothorax resolution was 2.5 days, and time to thoracic vent removal averaged 3.2 days. There were no immediate recurrences or significant complications. We conclude that the thoracic vent is an effective device for initial and definitive therapy of simple pneumothorax.

Adult↗
PubMed1991

Pneumothorax with Pneumocystis carinii pneumonia in AIDS. Incidence and clinical characteristics.

A retrospective review of the charts of patients with the acquired immunodeficiency syndrome (AIDS) was performed at three university-affiliated teaching hospitals in Denver between May 1982 and April 1987. Patients were evaluated for the presence or absence of Pneumocystis carinii pneumonia (PCP) and for the occurrence of pneumothorax at any time during their clinical course. The incidence of pneumothorax in AIDS patients with PCP was 9.0 percent (8/89), compared with 0 percent (0/45) in AIDS patients without PCP (p less than 0.03). All of the pneumothoraces resolved, most without chest tube placement. This study suggests that in patients with AIDS, PCP is associated with an increased incidence of pneumothorax, while AIDS patients without PCP are not at increased risk for the development of pneumothorax.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Evaluation of conventional chest tube therapy for iatrogenic pneumothorax.

STUDY OBJECTIVE: To assess conventional, large chest tube therapy in iatrogenic pneumothorax and to determine the optimal moment when to use more invasive procedures. DESIGN: Retrospective chart review. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Forty-seven patients with needle-induced iatrogenic pneumothorax. Twenty-four patients had an underlying pleural or pulmonary disorder. INTERVENTIONS: After insertion of a 20- to 24-French plastic chest tube connected to an underwater seal, suction was maintained until gas egress stopped or up to 10 days in patients with a persisting gas leak. RESULTS: In 96 percent, a definite occlusion of the pneumothorax was achieved. In all patients without an underlying lung disorder, gas egress stopped definitely after 72 h. In the presence of an underlying lung disorder, 92 percent of the pneumothoraces were healed after 10 days of continuous suction therapy. At 72 h, only 71 percent of the latter group were healed (p < 0.05 vs patients without lung disease). No major complication of chest tube therapy occurred. CONCLUSION: Conventional chest tube therapy is a safe and effective treatment for iatrogenic pneumothorax. In patients with an underlying lung disease, gas egress may last for up to 10 days. In these patients, the earlier use of a more invasive approach may be justified if the air leak persists.

Adult↗
PubMed2004

Effects of additional minocycline pleurodesis after thoracoscopic procedures for primary spontaneous pneumothorax.

STUDY OBJECTIVE: To evaluate the safety and efficacy of additional minocycline pleurodesis after thoracoscopic treatment of primary spontaneous pneumothorax. DESIGN: Retrospective comparative study with a historical control. SETTING: Thoracic surgical division of a university-affiliated tertiary medical center. PATIENTS AND METHODS: Between April 1994 and April 2001, 313 consecutive patients (minocycline group) with primary spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. The procedures included resection of the blebs and mechanical pleurodesis by scrubbing the parietal pleura. After operation, minocycline hydrochloride, 7 mg/kg, was instilled into the pleural space through a thoracostomy tube. The control group consisted of 51 consecutive patients who underwent the same thoracoscopic procedures alone for primary spontaneous pneumothorax between January 1992 and April 1994. RESULTS: There was no significant difference between the two groups in terms of demographic data, operative findings, and operation time. Chest pain was a common complaint after minocycline pleurodesis, but the total doses of requested analgesics were comparable in both groups. The rate of prolonged air leaks was significantly lower in the minocycline group (7.0% vs 17.6%, p = 0.025). Patients treated with minocycline had shorter periods of postoperative chest drainage and hospitalization. The ipsilateral recurrence rate was also significantly lower in these patients (2.9% vs 9.8%, p = 0.033). CONCLUSIONS: Minocycline pleurodesis is a safe and convenient procedure that may improve the outcome and reduce the rate of recurrence after thoracoscopic treatment for primary spontaneous pneumothorax. A randomized control study may be needed to confirm the findings.

Adolescent↗
PubMed2004

Kapalabhati pranayama: breath of fire or cause of pneumothorax? A case report.

Spontaneous pneumothorax is the most common cause of pneumothorax. We report a case of a 29-year-old healthy woman who presented to the emergency department with a spontaneous pneumothorax caused by a yoga breathing technique called Kapalabhati pranayama, or breath of fire. Yoga breathing exercises are commonly practiced, and a limited number of studies have shown various physiologic benefits of yoga breathing. This is the only known report of spontaneous pneumothorax caused by pranayama, but some other rare causes are noted. This case should illustrate that adverse side effects can occur when one pushes the body to physiologic extremes.

Adult↗
PubMed2005

Pneumothorax-associated pleural eosinophilia in mice is interleukin-5 but not interleukin-13 dependent.

STUDY OBJECTIVES: To establish a murine model of pneumothorax-associated pleural eosinophilia and to examine the role of interleukin (IL)-5 and IL-13 in the pathogenesis of this reaction. DESIGN: An animal study. INTERVENTIONS: One hundred thirty-seven C57/Bl-6 mice were used in this study. Wild-type animals were injected intrapleurally with 0.4 mL of air and were killed at different time points (30 min to 7 days) after the injection. IL-5 knockout and IL-13 knockout animals were killed 24 h and 48 h after the injection. Pleural inflammation was assessed by pleural lavage (PL). MEASUREMENTS AND RESULTS: PL cells were significantly increased following the induction of pneumothorax. The peak number of neutrophils, observed at 12 h, was 900 times higher than the control. The peak number of eosinophils, observed at 48 h, was 700 times higher than the control. Lymphocytes and mononuclear cells increased threefold and fourfold, respectively. IL-5 knockout mice had significantly less PL eosinophils than that the wild-type or the IL-13 knockout mice at 24 h (150 +/- 46/microL, 903 +/- 244/microL, and 912 +/- 168/microL, respectively; p = 0.013) and 48 h (181 +/- 45/microL, 1,587 +/- 212/microL, and 1,379 +/- 364/microL, respectively; p = 0.003). CONCLUSION: Pneumothorax induces an inflammatory reaction of the mouse pleura, mainly characterized by increased neutrophils and eosinophils. IL-5 but not IL-13 is required for pneumothorax-associated pleural eosinophilia.

Animals↗
PubMed2005

Spontaneous pneumothorax in Wegener granulomatosis.

Spontaneous pneumothorax in Wegener granulomatosis (WG) is uncommon. Three cases of pneumothorax that occurred early in the course of this vasculitis are reported. In the first patient, the disorder was disclosed by a pyopneumothorax. In the second patient, a rupture of the subpleural cavitary nodule into the pleural space was observed. In the third patient, the pneumothorax was discovered at the same time as a pulmonary hemorrhage. The three patients improved with immunosuppressive therapy. In WG, the pulmonary nodules are predominantly in the subpleural location, which entails the risk of pneumothorax and therefore require particular attention.

Granulomatosis with Polyangiitis↗
PubMed1982

Management of spontaneous pneumothorax with small lumen catheter manual aspiration.

We reviewed the case histories and roentgenograms of 50 patients with spontaneous pneumothorax who underwent small lumen catheter aspiration. The results were analyzed with regard to the presence or absence of preexisting lung disease. Patients with no history of previous lung disease and no roentgenogram abnormality other than the pneumothorax had a 66 percent chance of successful reinflation using the technique of manual aspiration described here. Patients with evidence of tension pneumothorax, bullae, pleural adhesions, and active tuberculosis were treated unsuccessfully. None of the patients experienced any complication from this procedure. Our results indicate that many patients with spontaneous pneumothorax may be quickly and successfully treated with small lumen catheter manual aspiration.

Adolescent↗
PubMed1984

Clinical evaluation of a percutaneous pneumothorax catheter.

This study prospectively evaluates the efficacy and complications of the percutaneous pneumothorax catheter. Twenty-five patients were treated with the percutaneous catheter for 19 episodes of spontaneous or iatrogenic pneumothorax, six malignant effusions, and one infected bulla. The catheter was effective in all but a single episode of spontaneous or iatrogenic pneumothorax and was especially useful in three patients with tension pneumothorax. Further experience is required to define fully its feasibility in the treatment of malignant effusions or infected bullae. The ease of insertion, good response, and low incidence of complications suggest that this catheter may be a useful alternative to tube thoracostomy in selected situations.

Adult↗
PubMed1985

Spontaneous pneumothorax. A complication of lung cancer?

Among 338 adults (258 men and 80 women) presenting with spontaneous pneumothorax, there were six men with lung cancer: five squamous cell carcinoma and one oat cell carcinoma. Pneumothorax led to the diagnosis in five cases and the remaining occurred as a complication of known neoplastic disease. The average age was 67 years. We analyze these six cases, along with 46 others from the literature. In patients less than 40 years old with normal chest x-ray film findings after lung expansion, further investigation for neoplastic disease is not justified. However, heavy smoking, chronic bronchitis, bullous emphysema and incomplete lung expansion after chest drainage in patients over 40 years old are indications for cancer screening through sputum cytologic study, bronchoscopic examination and surgical exploration. The occurrence of a pneumothorax neither alters the treatment of the underlying disease nor modifies the one-year prognosis. Five-year survival is nil, suggesting that lung cancers present as pneumothorax at an advanced stage of disease.

Aged↗
PubMed1986

Pneumocystis carinii pneumonia with spontaneous pneumothorax. A report of three cases.

Spontaneous pneumothorax is a rare complication of pneumonia. Three cases of spontaneous pneumothorax in patients with Pneumocystis carinii pneumonia and acquired immunodeficiency syndrome are described. Two patients had bronchopleural fistulas. Local subpleural necrosis was felt to be the cause of the pneumothorax. Pneumothorax should be considered in patients with P carinii pneumonia who experience respiratory deterioration.

Acquired Immunodeficiency Syndrome↗
PubMed1982

A new simple method to detect an air-leaking lung field in pneumothorax by a flexible bronchofiberscope.

A new simple method was designed to detect an air-leaking lung field in refractory pneumothorax. A constant volume of 100% helium gas was introduced into each lobe bronchus of two patients with pneumothorax via a flexible bronchofiberscope. In both patients, only when helium gas was introduced into the communicating bronchus with a ruptured emphysematous bullae, a high concentration of helium was detected in the intrathoracic gas. Thoracotomy has been used for patients with pneumothorax in which an air-leakage has persistently as well as recurrently continued, but this therapeutical approach has been frequently limited by a patient-age and an underlying disease. An exact detecting of the site of air leakage makes much expectant of an effectiveness of the outlet-closing treatment under a thoracoscope and finally leads to a new transbronchial treatment of pneumothorax.

Adult↗